Organization
COMPANION CARE OF SOUTHWEST LOUISIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WALLACE (ADMINISTRATOR)
(337) 463-3550
Entity
Organization
Contact information
Practice address
1014A N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
Mailing address
1014A N PINE ST, DERIDDER, LA 70634-2818
(337) 463-3550
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
15351
LA
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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